Health Times January 2019

January 2019

New Year, New Career Feature + Be a man - nursing from a male perspective + No more night owl - how to manage when you love nursing but loathe night shift + Be your own boss - the pros and cons of private practice + Art imitates therapy: the healing power of creativity

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HealthTimes - January 2019 | Page 03

January 2019 We hope you enjoy perusing the range of opportunities included in this issue.

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HealthTimes - January 2019 | Page 05

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Be a man - nursing from a male perspective

I

n the almost 24 years that Hugh Churchward has been a nurse, he’s seen some major changes around how society views male nurses.

“The assumption that a nurse will be a female has definitely changed,” says Mr Churchward.

“And there is also not the assumption that as a male nurse you are probably gay, which was truer when I started my course.”

Although Mr Churchward grew up in an environment dominated by the medical profession – his father a GP, his sister a nurse and his brother a pharmacist – nursing wasn’t an automatic career choice.

“I was living in a squat in London in 1991, surviving on about $150 per week, and had done labouring for several months on a building site, and this was the impetus to start thinking about other options.

“Someone mentioned nursing … and the idea started to fit like a well-worn pair of shoes “I also realised that with a nursing degree I could travel pretty much anywhere which in my early 20s was a pretty appealing option.

“My training was more of a humanitiesbased training as opposed to heavy in science with a big emphasis on sociology, psychology as well as anatomy and physiology and patho-physiology. This really Page 08 | HealthTimes.com.au

helped me frame how I approached nursing at the time and still does.”

Combining part-time nursing with part-time psychotherapy work, most of Mr Churchward’s nursing roles have been as a general Registered Nurse “This has been working in both a ward setting and within an outpatients department “Much of my nursing has been in palliative care, oncology and haematology.

I also had an extended role as an apheresis nurse for several years.”

For Mr Churchward, the most appealing thing about nursing is the relationships formed.

“Especially with the patients.

“I also enjoy the teamwork aspect of the job but of course that depends on who one is working with – that can be one of the most frustrating things about the job also.

“I also love the problem solving one has to do in the role – even down to the dance of organising one’s day when it is really busy.”

Over the course of his career, Mr Churchward says he’s consistently encountered around 1 male nurse in every 7, within each of the places he’s worked.

“I have always given patients – especially women – the option of whether they would prefer a female.

“Especially if it’s around showering, going to the toilet or catheters.

“There is very little time where it has been an issue.

“That is probably not so true in the outpatient’s department where we sometimes have to catheterise – I will generally get the female nurses to do that.

“It feels different than on the ward, but I have not really put it to the test given there are enough females around who can do it.”

Although it’s rare, on occasion Mr Churchward has been asked to swap with a female nurse, but he says he’s totally fine with those sorts of requests.

“If a patient has said something – prior to me asking or if I had not asked – I generally have apologised for not checking and saying that’s fine before getting someone else.

“I have never had a problem with that.”

To young men considering nursing as a career option, Mr Churchward says to go for it.

“Be clear about where you would like to go and work towards it.

“But don’t be in a rush and enjoy the day to day aspects of the job – you’ll learn a lot about people, relationships and how things work.

“Don’t be too ideological and driven but rather take the time to listen and learn.”

HealthTimes - January 2019 | Page 09

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Page 10 | HealthTimes.com.au

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HealthTimes - January 2019 | Page 17

No more night owl - how to manage when you love nursing but loathe night shift

N

ursing and nightshift are a professional pair widely accepted by the health community, but there are nursing careers that don’t subject nurses to the difficulties of working through the night. However, these positions are often limited, competitive and usually reserved for experienced nurses.

So, if you love nursing but loathe night shift, what are the options? There appears to be two –deal with the night shift by following important self-care strategies or find a career in nursing that allows you to work daylight hours.

Former Neonatal Special Care Nurse, Deb Herdman, worked the night shift for four years before the sleepless nights and exhaustion became too much. Ms Herdman said her circadian rhythm was so out of whack she needed to rethink her career options.

“At the end of the day, it’s natural to feel like you should be winding down, not having to fight against this and psyche yourself up for the night shift. This was particularly stressful for me, as I have never coped well with lack of sleep.

“I experienced chronic sleep deprivation signs which include difficulty falling asleep, waking at least once, twice or more and waking too early. On very rare of occasions when I slept eight hours – the gold standard I still felt exhausted.”

After the birth of her son, Ms Herdman said night shift became increasingly detrimental to her physical and mental wellbeing and robbed her of quality time with her young family.

“I began nightshift, as many nurses do, with a young child. He wasn’t a good sleeper as an infant and then became a toddler that could take hours to settle. This was difficult when on

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night duty as he refused to settle with his dad and I felt the need to rest and have some me time, before beginning night duty.

“On the nights when I wasn’t working, I longed to go to bed, so I felt anxious that he wasn’t keen on sleeping.

“Nightshift definitely had a physical and emotional effect on me. I think for those years, despite thinking I was at home and available to my toddler son all day, the quality of time was poor. I felt stressed and tired constantly. By the time I ‘recovered’ I was back on duty.”

It wasn’t for lack of trying, said Ms Herdman, as sleep didn’t come easily despite using sleep aides such as blackout blinds, earplugs and eyeshades.

“I only ever slept five to six hours. It was exhausting! Like most night shift workers, it’s the adrenaline and cortisol rush that prepare you for the arduous task of nightshift.

“On one occasion I thought I was on night duty only to arrive at work and be told I wasn’t rostered. I didn’t sleep at all that night as my adrenaline and cortisol levels had prepared me for work and not sleep.”

It was during her time as a neonatal nurse that Ms Herdman felt the impact of working nights most, as working with newborns necessitates an alert mental state.

“Although most shifts were routine care, it was challenging and stressful when emergency care was required. I particularly hated the two to three o’clock in the morning time when you were willing your mind and body to keep awake, concentrate and stay focused.

“On a lighter note, one night I went

to work and wondered why one shoe was squeaking on the vinyl floors. I ignored this minor annoyance; too tired to be bothered, until eventually, I looked down to see that I was wearing different shoes! Tiredness and lack of concentration make you do strange things.”

Losing weight after pregnancy was also challenging due to the physiological impact of working night shift, said Ms Herdman, and a diagnosis of hypothyroid only exacerbated the situation.

“I didn’t eat a lot on the shift, but I found I was eating a lot before. I thought my body was trying to give me energy, but it was a hormonal imbalance.

“Leptin and ghrelin are hormones produced when we sleep and control appetite and hunger.

Without these hormones being regulated, satiety cues are missed causing an absence of feeling full and feeling hungry.

“Your body sends the wrong signals regarding hunger. Less than six hours and over nine hours of sleep are the main contributing factors that cause these hormones to become unbalanced.”

Night shift doesn’t just affect nurses, friends and family suffer too, said Ms Herdman. “I was less tolerant and moody, particularly towards my husband. I found I did little socialising because the ‘jetlag’ feeling never seemed to go away until I had annual leave.”

It was the struggle with night shift and an unsettled baby that led Ms Herdman to start her own business, Nigh’ Nigh’ Sleepy Head, a music-based behavioural modification system, which was the result of research into

why sleep is essential and how night shift affects natural sleep patterns.

Lowered immunity, weight gain, diabetes, cardiovascular disease, breast cancer and prostate cancer are just some of the illnesses that a lack of adequate sleep causes, according to Ms Herdman.

Brett Holmes, General Secretary of the NSW Nurses and Midwives’ Association, said there had been various studies showing night shift increases the risk of serious health conditions, including cardiovascular disease, colorectal disorders, breast cancer, prostate cancer, diabetes and depression.

“These issues arise due to a number of factors, such as inadequate exercise and diet, disruption of social lives and sleep deprivation. These are cumulative effects over years of regular rostering onto night duty,” said Mr Holmes.

“Emotional health and the high stress and anxiety from lack of sleep was a strong part of my incentive to move away from night shift.

“Nothing is more important than your physical and mental health when you have parenting responsibilities,” said Ms Herdman.

A nursing career without night shift.

The positions least likely to do rotating night duty include Nursing Unit Managers (NUMs), Nurse Educators, Clinical Educators, Clinical Nurse and Midwife Consultants, Community Health Nurses and nurses or midwives undertaking research.

However, these jobs are competitive and

HealthTimes - January 2019 | Page 19

often require extra qualifications according to Mr Holmes.

Ms Herdman said it is possible to work as a nurse without enduring the night shift, and she is proof.

“A recent part-time position allowed me to decline night shift in perioperative nursing as part of my contract.

“My current position is on nurse bank where I can maintain my nursing skills as a scrub (scout) nurse and also manage my business as an infant and child sleep consultant.”

Many nurses are taking on management roles in larger hospitals, and these positions offer regular daytime hours, said Ms Herdman.

Another option for nurses who want to remain in the profession without night shift duty is community nursing, which is gaining in popularity as general practice and pharmacies are increasingly employing nurse consultants to add value for clients and customers, said Ms Herdman.

“Nurses can also negotiate night shift with employers. You may be exempt if you have a medical condition or your hospital may allow you to negotiate non-night duty options.”

Coping with night shift Working night shift is an almost unavoidable part of nursing and midwifery, said Mr Holmes, but many solutions can limit the impact of problems associated with shift work.

“Education programs on coping methods to improve diet, exercise and mental wellbeing need to be actively encouraged by

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management and local health districts.

“Breaks while working night shift must be enforced; swapping from night shift to day shift can be a difficult transition, and this needs to be factored into rostering to allow nurses and midwives to recuperate,” said Mr Holmes.

“I believe occupational health and safety need to manage expectations around night shift and actively promote healthier options for staff and safer care for patients.

“The days of rotating days, evening and nights don’t support best health practice or quality care. It’s time work practices changed,” said Ms Herdman.

“The current 15 per cent night duty penalty-rate for NSW public hospitals does not fairly compensate nurses and has not changed since 1975. NSW is way behind other states and territories with Tasmania’s rate at 25 per cent, and Western Australia at 35 per cent,” said Mr Holmes.

If night shift isn’t avoidable, it’s better to work night shifts in a block, and then switch back to day and evening hours, said Ms Herdman.

“Make sure you work out your night duty entitlement pro-rata if you work part-time.

You might like to split the required hours into a six or 12-month period.

“The worst health options will be working day, evening and nights on frequent rotations.

“For me, night shift would never be an option again,” said Ms Herdman.

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HealthTimes - January 2019 | Page 21

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HealthTimes - January 2019 | Page 23

Be your own boss - the pros and cons of private practice

A

fter many years of combining shift work and night duty with raising her own young children, midwife Caroline McMahon began to feel overwhelmed and exhausted.

“I was becoming ill,” says Ms McMahon.

“I loved working within a busy hospital environment, the camaraderie with staff, constantly learning new skills and developing existing ones, lots of structure and regular pay.

“But the downside was that the dayshifts were not suitable to my family and nights were becoming increasingly harder for my body to cope with.

“Balancing the joy of both raising my children and continuing to work within a framework that wasn’t flexible made being able to work very difficult.”

But instead of leaving the career she so loved, Ms McMahon decided to her hand at private practice, in order to work the hours that suited her and her family.

“Friends were turning to me to assist them as they had their babies,” she says.

“Soon, I found friends of friends and people outside of my friends’ circle were calling me to assist them, so I started a business to cater for the demand.”

To begin with, Ms McMahon set herself up as a sole trader, and set about meeting the needs of those women who were approaching her to assist.

“Initially I went casual at the hospital while I built up my practice, this gave me the flexibility to grow my business and the security of money coming in while I did this.”

In 2006, Ms McMahon set up a company with her business partner, and sought the advice of solicitors, bookkeepers, accountants and insurance brokers to ensure they were meeting relevant standards.

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“We had never run a company before and found investing in expert advice to be invaluable.

“I ensured I kept up my midwifery education to meet registration standards.”

The evolution of technology meant Ms McMahon could develop a website, making her accessible to a wider range of clients, and since then, she’s never looked back.

“Being able to offer a service that our clients need, that is not available anywhere else, the joy of being able to support a new family is amazing.

“We can listen and have more freedom to deliver this service within safe guidelines for both the family and myself building a relationship of trust and support with our clients.

“I also have the flexibility in my working hours when I need them.”

As a private midwife, an average day for Ms McMahon starts with checking emails before heading off for morning home visits.

“The mornings is where I do most of my first visits. Often I’m home in the early afternoon eating lunch at my desk and answering emails and phone calls.

“I try to step away from the office between 4.30pm and 5pm.

“I offer two to three evenings per week as well as overnight midwifery support. My days vary in face-to-face and remote work, and also includes social media updates, media, administration and education updates.”

Like with anything though, there are some downsides.

“Being self-employed is the hardest I have ever worked.

“There is no one to fill in for me if I have a sick day, no sick leave and no holiday pay.

“Much of the fee I need to charge to stay in business does not go to me, people who have never worked for themselves before don’t

understand where the money needs to go to stay fluid.

“I also need to service my current clients, who are often very stressed and sleep deprived, which is emotionally draining on myself, while ensuring I have work for the coming weeks ahead.”

For Kathy Fray, the decision to embark on a private practice was made at the very beginning of her career.

“I just was never really the hospital shiftworking type of Midwife,” says Ms Fray.

“The rules, regulations, limitations, protocols, hierarchy, obstetric impatience leading to unnecessary interventions.”

Initially, Ms Fray went about building her self-employed caseload as quickly as possible, to be able to leave her part-time role at the hospital.

“But of course each new client has typically only just become pregnant, so it took 8-9 months for me to be able to become a full-time

self-employed, case-loading midwife.”

Ms Fray says working as a self-employed midwife was the best decision of her career.

“Being your own boss - planning your own days most of the week.

“And always that hit of adrenaline when your phone rings. On-call midwives are typically Adrenaline Junkies.”

According to Ms McMahon, demand for independent midwives is increasing, as in-home services become a more accepted choice for addressing the multifaceted challenges faced by new families.

While private practice fits well into Ms McMahon’s life, she suggests thinking long and hard before leaving the hospital for good.

“It’s a lifestyle choice,” she says.

“Be prepared to work very hard, and if you love what you do, it will love you.”

HealthTimes - January 2019 | Page 25

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Page 26 | HealthTimes.com.au

PR E

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Go to amh.net.au for more information. *Terms & Conditions Apply. For full details and conditions of entry and to order your AMH resource, just go to www.amh.net.au. NSW Permit No. LTPS/18/27893. ACT Lic. No: TP 18/01762. SA Lic. No: T18/1613. The promoter is Australian Medicines Handbook, Level 13, 33 King William St, Adelaide SA 5000. The random prize draw will take place at Level 13, 33 King William St. Adelaide 11am on 25/1/19. Winners will be notified by email by 31/1/19 and draw results published on AMH website on 31/1/19. All values include GST.

HealthTimes - January 2019 | Page 27

Art imitates therapy: the healing power of creativity

A

child on the Autism spectrum, a young woman coping with work stress and a boy dealing with the separation of his parents, all vastly different cases, but all with one thing in common: putting a problem in a visual medium helped them to engage in therapy.

What is art therapy?

Arts therapy is based on the belief that the process of engaging creatively in art making within a therapeutic relationship supports changes in one’s inner and outer world, according to psychologist and art therapist Shaun Spicer.

“Arts therapists may specialise in one of the creative modalities or use a combination of artistic expression depending on the intentions or experience of their clients,” said Mr Spicer.

However, it’s not about the art, according to counselling psychologist Jay Anderson of a South West Wellbeing Centre in Western Australia, who uses art therapy as part of a multimodal approach to help clients uniquely explore their thoughts and feelings.

“Art therapy is a general term, not unlike ‘counselling;’ it’s not about the art, but the therapy involving artistic materials and art processes. It is the process of acknowledging the emotion or issue, expressing it, sharing it and the integration of the process that is key.

“Counsellors and therapists that engage with

Page 28 | HealthTimes.com.au

art therapy may have different activities they utilise, or they may use a particular process to allow the client to learn more about themselves or to explore an issue.

“Often art therapy is useful in expressing and resolving emotions, allowing a deeper therapeutic process, and perhaps more subconscious involvement in the therapy,” said Ms Anderson.

What type of client benefits most from creative therapies?

Arts therapy is beneficial to people of all ages and abilities and embraces a variety of psychotherapy frameworks, said Mr Spicer.

“Art is a visible representation of intangible thoughts and feelings, often feelings that are hard to verbalise.

“Giving voice to these inner thoughts and feelings empowers clients in a safe, confidential nurturing environment. Participants can explore their imagination and creativity, identifying issues and concerns and increasing their intra and interpersonal skills.

“Art making has been shown to decrease stress and anxiety and is an effective form of communication across all ages, cultures and social groups, empowering those with mental health conditions to be engaging within their communities,” said Mr Spicer.

The majority of other therapies and counselling techniques that improve mental

health are verbal and cognitive, which isn’t ideal for every client, said Ms Anderson.

“Some people are more suited to creative therapies, and art therapy is one category that engages different parts of the brain and body in the therapeutic process.

“In the same way that there are many learning styles and personalities, likewise, in counselling, there are many techniques and modalities, and methods of working that connect better with some clients.

“Some people may be cognitive, and thought focussed, they may feel more comfortable in standard therapies involving techniques that engage their brain or their thinking processes.

Other people connect to their emotions through drawing or may better integrate an issue in making something, or in painting it,” said Ms Anderson.

This doesn’t mean only ‘creative’ or ‘artistic’ types are suited to art therapy, explained Ms Anderson, as every client has emotions and challenges, but some people work through an issue better through a creative outlet.

Facilitating counselling

art

therapy

sessions

in

Art therapy sessions range in duration from 40 to 60 minutes, depending on the client’s age, and can be facilitated on a one-to-one basis with individuals, or in groups, families and communities, said Mr Spicer.

The sessions can include a variety of mediums, such as clay, play dough, plasticine, collage, paint and pencils, said Mr Spicer, but poetry, singing and even performing is part of the art therapy experience.

“The emphasis is always on the process of creating and to make meaning rather than the end product,” he said.

Art therapy can be facilitated as a component of other counselling techniques to explore issues further or to express emotions,

said Ms Anderson, while other art therapists use art throughout the entire session.

“Some art therapists may direct the client and have a planned activity or process while others may be non-directive and allow the client to lead the process, which encourages flexibility, change and openness,” said Ms Anderson.

Benefits of art therapy as a treatment modality • Allowing emotional expression • Facilitating resolution of trauma • Integration of concepts • Improved sleep and functioning • Improved mood and reduced anxiety • Increased self-compassion • Increased self-esteem and confidence • Development of healthy coping skills • Resolution of inner and outer conflicts • Identifying blocks to emotional expression and personal growth Many creative therapies are highly beneficial and can assist clients with a range of issues, said Ms Anderson, making it an ideal adjunct to psychological treatment.

Art therapy is a valuable tool to improve and enhance the physical, emotional and mental health and well-being of many clients, added Mr Spicer.

“It’s a vehicle for self-expression, and also enhances self-reflection and discovery, which would be an asset to any clinic,” he said.

There are many short workshops and courses available to gain skills in facilitating art therapy, but Ms Anderson highly recommends personal work in this area to experience the benefits firsthand.

“When a therapist experiences the technique, they can see and experience the benefits themselves - and it is much easier to remember an activity or a process if you were “in” it than if you read about it, or saw it occur.”

HealthTimes - January 2019 | Page 29

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Page 30 | HealthTimes.com.au

K I N G F A I S A L S P E C I A L I S T H O S P I TA L & RESEARCH CENTRE Information & Interview days

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Hospital Representaaves will be holding Informaaon sessions and interviews in Australia & New Zealand 26 February – Sydney 20 February – Auckland 21 February – Christchurch 28 February – Melbourne 4 March – Perth 25 February – Brisbane Registered Nurses, Educators & Managers in all specialles* are encouraged to apply.

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HealthTimes - January 2019 | Page 31

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